Ateneo de Zamboanga University

College of Nursing
NURSING SKILLS OUTPUT (NSO)
Report No. 10
RADIOACTIVE UPTAKE and (1311 UPTAKE) EXCRETION TEST
I.

DESCRIPTION:

A radioactive iodine uptake (RAIU) test uses a radioactive tracer and a

special probe to measure how much tracer the thyroid gland
absorbs from
the blood. The test can show how much tracer is absorbed by the thyroid
gland and if it is evenly spread in the gland. This helps your doctor know if the
thyroid gland is working properly. The radioactive tracer commonly used in
this test is iodine.
A radioactive iodine uptake test is done to find problems with how the thyroid
gland works, such as hyperthyroidism. An RAIU test may be done at the
same time as a thyroid scan.

II.

MATERIALS /EQUIPMENT NEEDED:

radioactive iodine in the form of capsule or fluid,
scintillation counter
The dose is typically 0.150.37 MBq (410 Ci) of 131I sodium iodide, or 3.77.4 MBq (100
200 Ci) of 123I sodium iodide.

III.

PROCEDURE

1.

Explain the test and the purpose of the test to the patient. He will need to begin fasting at
midnight the night before the test. Explain that he will receive the radioactive iodine in capsule
or liquid form and then be scanned at the 6-hour interval and again at a 24-hour interval. If
the patient is an inpatient, the nurse or a technician will administer the dose to him right on
the nursing unit at the specified time. Be sure to note the exact time the dose is administered.
If he is an outpatient, the patient will usually be given the capsule to take at home at a certain
time. Be sure you instruct the patient to take the dose at the specified time. If he misses the
exact time, be sure to have the patient write down the exact time he did take the dose. Be
sure to explain that the test is painless. Be sure to explain that the radioactive material is very
small and will not harm him.
Check the patient's history for IODINE EXPOSURE , which may interfere with the test results.
Note any prior radiological tests using contrast media, nuclear medicine procedures, or
current use of iodine preparations or thyroid medications on the film request form.
Substances containing iodine, such as dyes used for the intravenous pyelogram (IVP),
gallbladder series, or bronchograms may cause incorrect test results. Iodine hypersensitivity
(allergy) is not considered a contraindication for this test because the amount of iodine used
is similar to the amount consumed in a normal diet.
Radioactive iodine uptake testing is contraindicated during pregnancy and lactation because
of possible teratogenic effects.
After ingesting an oral dose of radioactive iodine, the patient's thyroid is scanned at 6 hours
and at 24 hours by placing the anterior portion of his neck in front of an external single
counting probe.
Instruct the patient to resume a light diet 2 hours after taking the oral dose of radioactive
iodine. When the study is complete, the patient may resume a normal diet.

2.

3.
4.
5.

IV.

DIAGRAM/ILLUSTRATION:

V.

NURSING RESPONSIBILITIES :
Before procedure:

Do not eat for 2 hours before the test.

For an RAIU, you will swallow a dose of radioactive iodine. Iodine can be taken
as a capsule or a fluid 4 to 24 hours before the test. Iodine has little or no
taste.
Just before the test, you will remove your dentures (if you wear them) and all
jewelry or metal objects from around your neck and upper body.
Before a radioactive iodine uptake (RAIU) test, you need to sign a consent
form that says you understand the risks of the test and agree to have it done.
Talk to your doctor about any concerns you have regarding the need for the
test, its risks, how it will be done or what the results will mean.
Do not take any antithyroid medicine for 5 to 7 days before the test.
Your doctor may ask you to eat a low-iodine diet.
During procedure

Explain the test and the purpose of the test to the patient. He will need to begin fasting at
midnight the night before the test. Explain that he will receive the radioactive iodine in capsule or
liquid form and then be scanned at the 6-hour interval and again at a 24-hour interval. If the
patient is an inpatient, the nurse or a technician will administer the dose to him right on the
nursing unit at the specified time.
Radioactive iodine uptake testing is contraindicated during pregnancy and lactation because of
possible teratogenic effects.

After ingesting an oral dose of radioactive iodine, the patient's thyroid is scanned at 6 hours and
at 24 hours by placing the anterior portion of his neck in front of an external single counting
probe.

Instruct the patient to resume a light diet 2 hours after taking the oral dose of radioactive iodine.
When the study is complete, the patient may resume a normal diet.

After procedure

At 6 hours, 5% to 20% of the radioactive iodine should accumulate in the thyroid. At 24 hours,
accumulation should be 15% to 40%. The balance of the radioactive iodine is excreted in the
urine. Local variations in the normal range of iodine uptake may occur due to regional differences
in dietary iodine intake and procedural differences among laboratories.
Below-normal iodine uptake may indicate hypothyroidism, subacute thyroiditis, or iodine overload.
Above-normal iodine uptake may indicate hyperthyroidism, early Hashimoto's thyroiditis,
hypoalbuminemia, lithium ingestion, or iodine-deficient goiter. However, in hyperthyroidism, the
rate of turnover may be so rapid that a false normal measurement occurs at 24 hours.

Reference:
Medical -Surgical Nursing by Lewis Dirksen
http://www.netplaces.com/thyroid-disease/hyperthyroidism/radioactive-iodineuptake-raiu-and-scan.htm

September 29, 2014

CHARLITA F. AHMAD RN MN
Date
Clinical Instructors Initials

MS.

MARINEL MUFAN
BSN III-C

Ateneo de Zamboanga University

College of Nursing
NURSING SKILLS OUTPUT (NSO)
Report No.11
TRH SIMULATION TEST
I.

DESCRIPTION:
Prior to the availability of sensitive TSH assays, thyrotropin releasing
hormone (TRH) stimulation tests were relied upon for confirming and
assessing the degree of suppression in suspected hyperthyroidism.
Typically, this stimulation test involves determining basal TSH levels and
levels 15 to 30 minutes after an intravenous bolus of TRH. Normally, TSH
would rise into the concentration range measurable with less sensitive TSH
assays. Third generation TSH assays do not have this limitation and thus
TRH stimulation is generally not required when third generation TSH assays
are used to assess degree of suppression.
TRH-stimulation testing however continues to be useful for the
differential diagnosis of secondary (pituitary disorder)and tertiary
(hypothalamic disorder) hypothyroidism. Patients with these conditions
appear to have physiologically inactive TSH in their circulation that is
recognized by TSH assays to a degree such that they may yield misleading,
"euthyroid" TSH results.
Use and Interpretation:
Helpful in diagnosis in patients with confusing TFTs. In primary
hyperthyroidism TSH are low and TRH administration induces little or no
change in TSH levels
In hypothyroidism due to end organ failure, administration of TRH
produces a prompt increase in TSH
In hypothyroidism due to pituitary disease (secondary
hypothyroidism)administration of TRH does not produce an increase in TSH
In hypothyroidism due to hypothalamic disease (tertiary
hypothyroidism), administration of TRH produces a delayed (60-120
minutes, rather than 15-30 minutes) increase in TSH

II.

MATERIALS /EQUIPMENT NEEDED:

3 serum tubes
TRH 200 microgm (adults). The dose for children is 7 microgm/kg to a max 200
microgm.

III.

PROCEDURE

1.

The TRH Stimulation Test, however, is a much more sensitive test because it evaluates how well the
hypothalamus, pituitary and thyroid glands are functioning and communicating together at the same
time, and in in real time

2.

Begins by baseline thyroid and pituitary hormone levels being drawn.

3.

Then you are given an injection of a tiny amount of thyrotropin releasing hormone, which stimulates the
pituitary to release TSH, a hormone which signals the thyroid to release thyroxine, the main thyroid
hormone.

4.

A second blood sample is drawn 20 to 30 minutes later, and the TSH level is retested. Low
thyroid conditions will result in an exaggerated response, and excessive thyroid function and pituitary
insufficiency states will result in a depressed response.

IV.

DIAGRAM/ILLUSTRATION:

V.

NURSING RESPONSIBILITIES :
Before procedure:

Patient must discontinue thyroid medications 3-4 weeks before the test.
During procedure
Begins by baseline thyroid and pituitary hormone levels being drawn.
Then you are given an injection of a tiny amount of thyrotropin releasing
hormone, which stimulates the pituitary to release TSH, a hormone which
signals the thyroid to release thyroxine, the main thyroid hormone.
A second blood sample is drawn 20 to 30 minutes later, and the TSH level is
retested. Low thyroid conditions will result in an exaggerated response, and
excessive thyroid function and pituitary insufficiency states will result in a
depressed response.
After procedure

Normal basal values of TSH should be 0.2-6 IU/mL. The normal increment in TSH at 20 min should be
5-30 (mean 15) IU/mL with a slight diminution at 60 min.

Exaggerated TSH response is seen in primary hypothyroidism.

A flat response is seen in primary hyperthyroidism; but also in some apparently euthyroid patients
with ophthalmic Graves disease or multinodular goitre.

A delayed response with the TSH concentration lower at 20 than 60 min may be seen in
hypothalamic dysfunction.

Various drugs can modify the TSH response: it is reduced by glucocorticoids, DOPA agonists eg LDOPA, bromocryptine and fluoxetine; and enhanced by DOPA antagonists eg metoclopramide,
oestrogens and theophylline and sertraline (but ? only in thyroxine treated subjects).

In neonates, peak TSH responses < 35mU/L are not associated with subsequent hypothyroidism,
whereas responses > 35 mU/L are associated with a rate of subsequent hypothyroidism of 35%.

The TSH response is flat in most cases of TSHoma whereas in thyroid hormone resistance the TSH
response is brisk.

Reference:
Medical -Surgical Nursing by Lewis Dirksen
http://www.pathology.leedsth.nhs.uk/dnn_bilm/Investigationprotocols/Pituitaryprotoc
ols/TRHTest.aspx

September 29, 2014

CHARLITA F. AHMAD RN MN
Date
Clinical Instructors Initials

MS.

MARINEL MUFAN
BSN III-C